Provider Demographics
NPI:1538386974
Name:JACKSON, ROBERT ALLAN (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLAN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-3406
Mailing Address - Country:US
Mailing Address - Phone:609-371-1596
Mailing Address - Fax:
Practice Address - Street 1:1 HAMILTON HEALTH PL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3542
Practice Address - Country:US
Practice Address - Phone:609-584-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01417800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist